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{ "pk": 17990, "title": "Stage B Heart Failure Is Ubiquitous in Emergency Patients with Asymptomatic Hypertension", "subtitle": null, "abstract": "<b>Introduction: </b>Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension.<p></p><p><b><b>Method: </b>T</b>his was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York. Adult (≥18 years of age) English- or Spanish-speaking patients who had an initial blood pressure (BP) ≥160/100 millimeters of mercury (mmHg) and second BP ≥140/90 mm Hg, and pending discharge, were invited to participate in the study. We excluded patients with congestive heart failure, renal insufficiency, and atrial fibrillation, or who were pregnant, a prisoner, cognitively unable to provide informed consent, or experiencing symptoms of hypertension. We assessed echocardiographic evidence of subclinical heart disease (left ventricular hypertrophy, and diastolic and systolic dysfunction).</p><p></p><p><b><b><b>Results:</b></b></b> A total of 53 patients were included in the study; a majority were young (mean 49.5 years old,[SD 14–52]), self-identified as Black or Other (n = 39; 73.5%), and female (n = 30; 56.6%). Mean initial blood pressure was 172/100 mm Hg, and 24 patients (45.3%) self-reported a history of hypertension. Fifty patients completed an echocardiogram. All (100%) had evidence of subclinical heart disease, with 41 (77.4%) displaying left ventricular hypertrophy and 31 (58.5%) diastolic dysfunction. There was a significant relationship between diastolic dysfunction and female gender [x2 (1, n = 53) = 3.98; P = 0.046]; Black or other race [x2 (3, n = 53) = 9.138; P = 0.03] and Hispanic or other ethnicity [x2 (2, n = 53) = 8.03; P = 0.02]. Less than one third of patients demonstrated systolic dysfunction on echocardiogram, and this was more likely to occur in patients with diabetes mellitus [x2 (1, n = 51) = 4.84; P = 0.02].</p><p></p><p><b><b><b><b>Conclusion:</b> </b></b></b>There is a high probability that Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure. Emergency clinicians should provide individualized care that considers their unique health needs, cultural backgrounds, and social determinants of health.</p>", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "hypertension" }, { "word": "Heart Failure" }, { "word": "Subclinical heart disease" }, { "word": "emergency department" }, { "word": "health disparities" } ], "section": "Cardiology", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0t02p5ch", "frozenauthors": [ { "first_name": "Kimberly", "middle_name": "", "last_name": "Souffront", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York; Center for Nursing Research and Innovation, Mount Sinai Health System, New York; Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York", "department": "None" }, { "first_name": "Bret", "middle_name": "P.", "last_name": "Nelson", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Megan", "middle_name": "", "last_name": "Lukas", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Hans", "middle_name": "Reyes", "last_name": "Garay", "name_suffix": "", "institution": "Mount Sinai Morningside, Department of Cardiology, New York", "department": "None" }, { "first_name": "Lauren", "middle_name": "", "last_name": "Gordon", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York; Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York; Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York", "department": "None" }, { "first_name": "Thalia", "middle_name": "", "last_name": "Matos", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Isabella", "middle_name": "", "last_name": "Hanesworth", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Rebecca", "middle_name": "", "last_name": "Mantel", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Claire", "middle_name": "", "last_name": "Shubeck", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York", "department": "None" }, { "first_name": "Cassidy", "middle_name": "", "last_name": "Bernstein", "name_suffix": "", "institution": "Center for Nursing Research and Innovation, Mount Sinai Health System, New York", "department": "None" }, { "first_name": "George", "middle_name": "T.", "last_name": "Loo", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York; Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York", "department": "None" }, { "first_name": "Lynne", "middle_name": "D.", "last_name": "Richardson", "name_suffix": "", "institution": "Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York; Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York; Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York", "department": "None" } ], "date_submitted": "2023-03-24T01:45:17Z", "date_accepted": "2023-03-24T01:45:17Z", "date_published": "2024-02-09T14:00:00Z", "render_galley": { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17990/galley/9602/download/" }, "galleys": [ { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17990/galley/9602/download/" } ] }